Contraceptive Pill Review

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For online postal service for oral contraception, please see www.sexualhealth.cnwl.nhs.uk/order-form.

Please confirm that you have no new concerns about this pill (if you have new concerns/questions please book an appointment to discuss further): *
Have you started any new medication since we last issued you a prescription for the pill? *

Please make an appointment with a health care professional – this form will not be able to be processed via the website.

Have you been diagnosed with any new health conditions since we last issued you a prescription? *

Please make an appointment with a health care professional – this form will not be able to be processed via the website.

Do you smoke? *
How many cigarettes do you smoke a day? *

Please make an appointment with a health care professional – this form will not be able to be processed via the website.

Do you suffer from migraines with aura (aura is when there are specific warning signs just before the migraine begins, for example visual disturbance)? *

Please make an appointment with a health care professional – this form will not be able to be processed via the website.

Please see NHS: Migraines for further information.

Please be aware that certain over the counter medicines and herbal remedies such as St Johns wort can reduce the efficiency of the pill. Please check with a health care professional if you have any concerns.

Have you ever experienced any bleeding after sex? *

Please make an appointment with a health care professional – this form will not be able to be processed via the website.

Have you ever had a blood clot? *

Please make an appointment with a health care professional – this form will not be able to be processed via the website.

Have any of your immediate family ever had a blood clot? *

Please make an appointment with a health care professional – this form will not be able to be processed via the website.

Have you ever had breast cancer? *

Please make an appointment with a health care professional – this form will not be able to be processed via the website.

Have any of your immediate family ever had breast cancer? *

Please make an appointment with a health care professional – this form will not be able to be processed via the website.

Information about what to do if you miss a pill can be found on the Family Planning Association website.

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Please read the following symptoms carefully:

  • A sudden sharp pain in your chest, breathlessness or coughing up blood
  • Painful swelling in your legs
  • Weakness, numbness or bad “pins and needles” in an arm or leg
  • Unusual headaches or migraines that are worse than usual
  • Sudden problems with your speech or eyesight
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If you develop any new conditions, tell your clinician so that they can check its safe for you to take the pill.

If you go into hospital for an operation or have an accident which affects the movement of your legs or mobility, tell the doctor you are taking the combined pill. You may need to stop taking the pill or need other treatment to reduce the risk of developing thrombosis (blood clots). There are other contraceptive methods you can use instead.

Be breast aware, visit www.nhs.uk/how-should-i-check-my-breasts for further advice.

It is important we check your blood pressure and weight while you are taking the pill.

Please see the Wellbeing Centre on Blood pressure for further information.

Please take the measurements below at the practice reception, in your local pharmacy or at home.

Blood Pressure

If you would like to read more about this and other contraceptive options please visit the Family Planning Association website and visit our contraception page on the website.

If at any time you have concerns about your medication then please an appointment with a health care professional, this can be the clinical pharmacist, nurse or GP.

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